Healthcare Provider Details

I. General information

NPI: 1023386711
Provider Name (Legal Business Name): AMERICAN PAIN RELIEF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SW BORLAND RD STE D2
TUALATIN OR
97062-8861
US

IV. Provider business mailing address

6464 SW BORLAND RD STE D2
TUALATIN OR
97062-8861
US

V. Phone/Fax

Practice location:
  • Phone: 503-885-8008
  • Fax: 503-885-8002
Mailing address:
  • Phone: 503-885-8008
  • Fax: 503-885-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOR

VIII. Authorized Official

Name: DAVID KIBEC
Title or Position: PRACTICE MANAGER
Credential:
Phone: 503-803-7248